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Old 05-04-2008, 11:39 PM   #1
keith10247
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ALS units on BLS calls


Good evening, I have been noticing a trend in the county I run in and I wanted to know if it was common everywhere else.

In our county, we have ALS units that are dedicated to being medic units 24x7. On many occasions, I have been dispatched to many BLS calls that were downgraded from an ALS call and the medic unit did not want to transport.

For example, my favourite was one evening the chief and I were doing a little grocery shopping and we get a call to assist a medic who was about 10 - 15 miles away in the next city. The pt was an adult female who had a minor seizure. We jump on the interstate and it turns out the medic and the pt's location were less than 2 miles from the hospital. The thing that got me was that the grocery store we were at was in our 2nd due. Our 2nd due did not have a BLS unit staffed. This call put us in our 3rd due which means their BLS unit was on a call or not staffed. Being at the edge of the county, that left the west end without a free BLS unit.

Is this normal? It seems that we should all have the same mission which would be to get people who need to go to the hospital there to the hospital in a timely fashion. The 10 - 15 mile drive put us on a busy street that has stop lights every 100 yards or so.


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Old 05-05-2008, 12:46 AM   #2
MAC4NH
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I don't know the arrangement of ALS vs BLS units in your area. In our area, the BLS far outnumbers the ALS. My guess is that they don't want to tie up an ALS unit on BLS patient and leave a potential ALS call uncovered.

In my agency we have a couple of transport-capable ALS units (a rarity in this state) and they hate to transport even ALS patients. BLS is dispatched to every call and we can cancel the ALS or they can triage the patient to us. We usually transport ALS patients in the company of the ALS unit. Once in a while, if the stars are aligned properly, they will cancel the BLS and transport the patient themselves.

The benefit to the patient in having both units transport is that the paramedic in the back has another pair of trained hands in the EMT-B if he/she needs them.
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Old 05-05-2008, 05:00 AM   #3
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We do not have that problem to such an extent anyway. Our ALS travel on fly cars, which makes them a bit more accesable, the the tendancy for them to get tied down with a BLS patient, also decreases. I can say with great surety that the BLS & ILS practitioners, far outnumber the ALS, hence it is a scarse recource that need to be well managed, as for any other recource as well. There are a few ALS who work on ambo/rig, but those are solely reserved for ALS/ICU transports, and are managed as such.
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Old 05-05-2008, 08:11 AM   #4
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What is a BLS truck LOL? JK, we run all ALS here. Even our Convo trucks are ALS. It would be nice to have BLS trucks, but I really don't think that will ever happen here. We usually have 2 medics on every truck. B)
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Old 05-05-2008, 08:25 AM   #5
Ridryder911
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Quote:
Originally Posted by keith10247 View Post
For example, my favourite was one evening the chief and I were doing a little grocery shopping and we get a call to assist a medic who was about 10 - 15 miles away in the next city. The pt was an adult female who had a minor seizure. We jump on the interstate and it turns out the medic and the pt's location were less than 2 miles from the hospital. The thing that got me was that the grocery store we were at was in our 2nd due. Our 2nd due did not have a BLS unit staffed. This call put us in our 3rd due which means their BLS unit was on a call or not staffed. Being at the edge of the county, that left the west end without a free BLS unit.
First, what is a "minor seizure"? Never heard of such, especially to be dispatched. This is why all units should be staffed with ALS. BLS has no reason for existence in EMS except non-emergency transport systems such as for transfer and taxi services, in which is really not EMS. ALS is not "too good" for BLS calls, one cannot predict when that patient can turn around and the condition may require ALS care. Such as the patient with seizures, may have recurrence of another seizure or become "status". Again, if ALS was initially dispatched, back-up would not be needed.

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Old 05-05-2008, 09:23 AM   #6
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BLS has no reason for existence in EMS except non-emergency transport systems such as for transfer and taxi services, in which is really not EMS.
I understand from earlier posts that in you work in a wide spread area with long response and transport times. In such an area ALS response to most calls is logical and appropriate.

I, on the other hand work in a densely populated urban area where there is an average response time of about 6 minutes and you are never more than 5 minutes from the nearest hospital.

A large percentage of our calls are classified as "sick". These are generally problems for which you would go to your private doctor. The patients making these calls do not have a private doctor so they go to the ER. It is a huge waste of talent and resources to send ALS providers for a patient with the sniffles, a toothache, or a psychiatric crisis.

Our EMD's triage the calls and will dispatch BLS for all calls and ALS only for calls such as chest pain, difficulty breathing, status seizure, altered mental status, LOC or trauma with significant MOI. BLS usually arrives first and assesses. If there is no immediately life-threatening condition, they will cancel ALS and transport. If ALS is on scene first and they find no immediate life-threat they will release the patient to the BLS.

This system works for us in part because our BLS is very busy and the EMT's are experienced. In suburban areas with less experienced volunteer EMT's and longer transport and response times, the system relies more heavily on the ALS.
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Old 05-05-2008, 02:13 PM   #7
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Originally Posted by Ridryder911 View Post
First, what is a "minor seizure"? Never heard of such, especially to be dispatched. This is why all units should be staffed with ALS. BLS has no reason for existence in EMS except non-emergency transport systems such as for transfer and taxi services, in which is really not EMS. ALS is not "too good" for BLS calls, one cannot predict when that patient can turn around and the condition may require ALS care. Such as the patient with seizures, may have recurrence of another seizure or become "status". Again, if ALS was initially dispatched, back-up would not be needed.

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I'm confused. It sounded to me like ALS was dispatched, assessed the pt and determined that BLS was all that was needed. Isn't this ALS doing what ALS is designed to do? Doesn't a medic have the skills to determine that? Are you suggesting that all postictal pts should be transported ALS because they 'might' seize again?
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Old 05-05-2008, 03:17 PM   #8
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i understood it as he thinks that every single 911 call, without exception, no questions asked should be handled by a medic unit and that the only thing bls techs are good for is taxi service.

my baby stubbed her toe and i want her taken to the H because this is my first child and im easily frightened. als response

i want narcotics because im an addict who is recognized by every H employee down to the janitor and i know i can get them at the er so i'll call 911. als response

i havent been sleeping well for around three years. im bored and lonely so i guess i'll call 911 and go to the er. als response.

yip. in R/r's book, apparently all are als calls. definitely no reason to give those types of calls to a bls truck and keep the medics in service for, and i mean this quite literally, a REAL call....
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Old 05-05-2008, 04:08 PM   #9
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Rid is responding to whats being called a "minor" seizure. That is call that ALS should be transfering. It could be ery serious and if something happens during the BLS transfer, there is nothing BLS could do outside of monitoring.

BLS is a taxi ride for the most part. Most of my calls are nothing more than picking up someone from home, putting them on my stretcher and transfering them to the ED. Any legit call where I may have something to do usually requires ALS anyway. Either the medics are there or on the way.
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Old 05-05-2008, 05:00 PM   #10
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Is an EMT trained well enough to make a differential diagnosis? NO. Are you certain that patient will not seize again? (patient's with hx. of seizure activity, are prone to more seizures, remember what is the #1 cause of re-current sz?) Are you sure that headache is not a subarachnoid bleed? As well, if they are calling you for a stubbed toe, why is EMS responding and transporting? Again, it goes back to administration and setting up the EMS.

Five minutes or fifty minutes is mute, don't breathe for five minutes, or can one assure no aspiration or v-fib is not going to occur in that five minute ride. Some of my most dramatic calls, have occurred within five minutes of the local hospital. We do NOT transport level I trauma to the local ER, we transport 30 miles or the patient is flown. No matter, if the occurrence happened in the local ER drive.

Ironically, I find it is the same ones that gripes about it; always refer to Paramedics should remember where they come from.

There is nothing wrong with ALS transporting BLS calls, the "in case" factor should be considered. How many posts do we read were the patent deteriorated in front of the EMT? An EMT/ Paramedic partner teamed up so the EMT can ride on BLS calls; in case the patient condition deteriorates and to allow the EMT to obtain experience.

Sorry, patients that pay for EMS deserves to get the best and have services offered to them if needed, not await if they are available. There really is not that much difference in expenditure on providing the difference, definitely one can offset the costs by appropriate charges and good administrative practices.

I believe "chase cars" "ALS" roving vehicles are excuses for Paramedics not having to be there. As well, an excuse for a service to charge additional expenses without providing that service. Yes, one still can charge for an ALS exam and tx. without the Paramedic transporting, it is the initial call that determines the rate that will be charged and treatment administered. ALS charges is based upon the procedure, and number of med.'s given, not who rode in with them.

Is there B.S. calls, you bet. Should there be no-transport guidelines, yes. BLS or ALS, it would not matter, tying up an EMS unit is tying it up.

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Last edited by Ridryder911; 05-05-2008 at 05:03 PM.
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